Cadaveric ECD Kidneys Do Not Worsen Outcomes for Patients 70+

Renal transplant recipients older than 70 years who receive cadaveric expanded criteria donor (ECD) kidneys are at no higher risk for mortality or transplant failure than those who receive cadaveric non-ECD kidneys, researchers reported online ahead of print in the American Journal of Kidney Diseases.

A team led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of Harbor-UCLA Medical Center in Torrance, Calif., analyzed data from 145,470 adult renal transplant recipients. Compared with non-ECD kidneys, ECD kidneys were associated, in fully adjusted analyses, with a 40% increased risk of death-censored graft failure in recipients aged 18 and older but younger than 35; a 31% increased risk in recipients 35 and older but younger than 55; a 38% increased risk in recipients 55 and older but younger than 65; a 36% increased risk in recipients 65 and older but younger than 70; a 32% increased risk in recipients 70 and older but younger than 75; and a 45% increased risk in recipients 75 and older.

In addition, compared with non-ECD kidneys, ECD kidneys were significant predictors of mortality in patients younger than 70 years. ECD kidneys were associated with a significant 46% increased mortality risk in patients 18 and older but younger than 35; 23% increased risk in patients 35 and older but younger than 44; 26% increased risk in recipients 55 and older but younger than 65 years; and 20% increased risk for patients 65 and older but younger than 70. ECD kidneys were not associated with increased mortality in patients 70 and older.

Compared with deceased donor kidneys, living donor kidneys were associated with better survival in all age groups and lower transplant loss risk in patients younger than 70 years, the researchers concluded.

Given other data showing that elderly transplant recipients have a 41% lower overall mortality risk compared with waitlisted candidates, the authors observed, elderly patients with end-stage renal disease should undergo transplantation with a living donor kidney if possible, as this offers the best survival. However, for patients older than 70 years who expect deceased donor kidneys, cadaveric ECD kidneys offer virtually the same survival and transplant failure outcomes as cadaveric non-ECD kidneys, they concluded.